Pregnancy after a Preemie: FAQ (7QT Vol. 22)

After yesterday's announcement, I thought I'd dedicate today's post to all those burning questions that *I'd* be dying to ask, but that *you* have far too many social graces to voice aloud. After all, when a first pregnancy ends in delivery at 27 weeks, a second pregnancy tends to have every one a little on edge.

1.) Was this planned?

As in, "were we charting?" Nope. As someone with chronic fertility issues, I've been fortunate to have always been under the care of a Napro Surgical Fellow, aka the Catholic infertility treatment gold standard. But after *years* post-Isaac of trying a multitude of treatments/surgeries/diets, we'd closed the door on there being a medical solution sometime around last August. Funny story: after years of multiple appointments per month for infertility treatment, when I arrived for my first ob appointment, I had to fill out the new patient form since it had been so long since I'd been there. Under the line, "How did you hear about us?" I wrote, "seriously?"

2.) So what was different this time?

Well, I can say for sure that it wasn't that I was more relaxed! My doctor asked the same question, and all I could offer in response was "I gained 15 lbs, and started a high stress BSN program?" In fact, a few weeks before we found out we were expecting, Mark and I were on a much needed date after the upheaval my going back to school full time had caused our family. We hadn't even made it to the movie theater yet, when he mentioned in passing that he was trying out a new password manager on his internet browser to see if he liked it better than the old one. (His master's is in information security, what can I say?) My response was to burst into tears, because "I couldn't handle one more thing being different!"

3.) Will the issues you faced in Isaac's pregnancy be a factor in how this one goes?

Um, yes, to put it mildly, see below for more. Acquaintances like to remind me that, "every pregnancy is different!" to which I think in my head, "but my cervix is still the same!" (Read: incompetent) Couldn't they have come up with a slightly less insulting medical diagnosis than "incompetent cervix?"

4.) But surely there are treatment options?

Yes, yes there are, and we've pursued them. All of them. Get comfy.

Way back in 2015, we met with a number of specialists, both locally and long distance, and came to the conclusion that the best option for me would be to have a permanently placed trans-abdominal cerclage (TAC) that would give me a greater than 90% chance of carrying my pregnancies full term with no physical restrictions during pregnancy (a huge concern for me, as we were the then proud parents of a super rambunctious toddler) The only catch was, after the cerclage was placed, I'd only be able to deliver via C-section. The trade off in our minds was a no brainer. Where do I sign? We were additionally lucky that although there aren't that many maternal-fetal medicine specialists that perform this surgery (even worldwide) we just happened to have one such doctor right down the road. Done and done.

5.) So you're all good now, right?

Not so much. Shortly after recovering from that surgery (which was like having another c-section, minus the baby part), I started having new, different and definitely more painful fertility issues. After another year of unsuccessful treatment, my Napro doctor (not the one who did the TAC) recommended a surgery with her because: lots of good reasons I won't go into. Anyway, we decided to go for it, knowing that there was every possibility there might not be anything she could "fix." We also agreed that this would be our last surgical intervention as far as trying to conceive was concerned. Good thing we did. I'll spare you the details but the words "cervical" and "erosion" were used in the same sentence, and the long and short of it was the TAC was not working, had probably never worked, was compromising my health, definitely was causing more harm than good, and had to be removed. Later, I followed up with a surgeon in Chicago who is the leader in the U.S. when it comes to this procedure to get his opinion on how this could have happened. In his entire decades long career, he'd seen this happen 4 times. Including me. Umm, yeah

6.) Wait, what? So where does that leave things now for this pregnancy?

Well, my cervix is still incompetent and now cerclage-less, so we were back to the more run-of-the-mill, but slightly less effective routine treatment for IC: a temporary cerclage placed vaginally during pregnancy but after the first trimester. It's the same procedure I had done when I was admitted to the hospital at 22 weeks with Isaac. Except this time, it was placed preventatively, not emergently, so there was a lot more cervix to work with. That was done back in April, so now we wait and see, and I'm under medical orders to take things easy.

There's lots of talk these days about bedrest not being effective in high risk pregnancies, and while that may be true for some, even many, in my case, gravity literally is a factor in carrying a baby to term. And so my doctors have me on limited activity. For now, I can be up and about 4-6 hours every day, but am not to do any lifting or bending down or housework or cooking or grocery shopping or laundry etc. Fun times. I finished the spring semester for my BSN program but am now on a medical leave of absence. Every two weeks, I meet with my mfm for a cervical length check via ultrasound and if it looks like things are shortening, my restrictions will increase, and/or I might need to be admitted to the hospital for bedrest there. So far, things are measuring great, and we hope and pray that it stays that way.

7.) How are you feeling about all this?

Bizarrely at peace? We've done what we can, and the risk for miscarriage has passed so that has me resting easier. We had zero input as to the timing of this baby's arrival, so clearly God's the one in charge. I will say though, I don't measure my pregnancy by my due date. Life after the NICU has me measuring it by other mile stones. July 6th is the official date of viability. July 28th is the equivalent of when Isaac was born (literally the most pregnant I have ever been!). If we make it to August 31st, my regular ob can deliver us at her regular hospital, because after 32 weeks, we wouldn't need a Level 3+ NICU close at hand. Anytime after October 5th would mean that this little guy is full term, which as they say in Louisiana, would be lagniappe!

Congrats for putting up with me until the end. Does that answer all your questions? Clearly, I've got no problem with my life being an open book, so ask away if there's anything you'd like to know! And I'm linking up with Kelly for good measure :)